Healthcare Provider Details

I. General information

NPI: 1457558819
Provider Name (Legal Business Name): COLLEEN MARIE MCCARTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BORDER ST
EAST BOSTON MA
02128-2432
US

IV. Provider business mailing address

360 RIVERWAY APT. #2
BOSTON MA
02115-6420
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-6560
  • Fax:
Mailing address:
  • Phone: 413-454-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: